| NPI | 1740539352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 61565) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2014007769) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2022-07-21 |